Age-stratified trends in 20 years of stress incontinence surgery in Australia

Abstract

Mid-urethral sling has become the standard SUI procedure being performed in Australia since its introduction in 1999. SUI operations have increased each year for patients aged over 65, with the greatest increase seen in patients aged over 84 - indicating expanded eligibility for SUI surgery in older women. However, since 2010, there has been a fall in SUI operations to below the pre-MUS baseline.

Recent trends in the management of pelvic organ prolapse in Australia and New Zealand

“…Between 2007 and 2015, there was a significant increase in the use of synthetic slings for urodynamic and occult stress urinary incontinence. This is consistent with Medicare data on overall sling usage for those years, even though Brown and King found a decline in total continence procedures since 2010 . While the rates of other continence procedures in 2007 were higher in our survey than Medicare data, they were almost the same in 2015.…”

Midurethral slings in the mesh litigation era

“…Interestingly, there is a steady increase in total SUI operations for women between 75- to 84-year-old and those over 84 years old but a decrease below pre-MUS baseline in 2014 in those aged 45- to 64-year old. They reported this decline as being contributed by 2 raison d’etre: (I) a shift of SUI management to nonsurgical options with pelvic floor rehabilitation and a larger uptake by local general practitioners where once it would have been referred on to specialty care; and (II) a reaction to the negative publicity of synthetic mesh complications generated by the transvaginal mesh debacle for prolapse repair (47). …”

Do we need better information to advise women with stress incontinence on their choice of surgery? Report from the ICI‐RS 2018

“…The ongoing debate about the safety of MUS has attracted growing interest from the media and increasing litigation . These developments have led to a paradigm shift with a significant decrease in the insertion of MUS around the world and an official “pause” in MUS surgery in England from July 2018…”

“…The ongoing debate about the safety of MUS has attracted growing interest from the media and increasing litigation. 6 These developments have led to a paradigm shift with a significant decrease in the insertion of MUS around the world 7,8 and an official "pause" in MUS surgery in England from July 2018. 9 Considering this evolving field, the purpose of this research Think Tank (TT) was to provide an update of the current knowledge about the safety and efficacy of SUI surgery, to review patient goals and expectations and to identify factors affecting decision making for surgery.…”